Healthcare Provider Details

I. General information

NPI: 1427085687
Provider Name (Legal Business Name): BRIAN O'HALLORAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 N FEDERAL HWY
FT LAUDERDALE FL
33306-1424
US

IV. Provider business mailing address

10051 5TH ST N STE 200
ST PETERSBURG FL
33702-2211
US

V. Phone/Fax

Practice location:
  • Phone: 954-564-1111
  • Fax:
Mailing address:
  • Phone: 727-824-0780
  • Fax: 813-514-8891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS9013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: